Cardiology & VascularEvidence-Based Golden Standard
CHA₂DS₂-VASc Stroke Risk in Atrial Fibrillation
Estimates annual ischemic-stroke risk in non-valvular atrial fibrillation to guide oral anticoagulation decisions.
C Congestive HF +1 · H Hypertension +1 · A₂ Age ≥75 +2 · D Diabetes +1 · S₂ Stroke/TIA/thromboembolism +2 · V Vascular disease +1 · A Age 65–74 +1 · Sc Sex category (female) +1
Annual stroke risk: 0 ≈0.2% · 1 ≈0.6% · 2 ≈2.2% · 3 ≈3.2% · 4 ≈4.8% · 5 ≈7.2% · ≥6 ≈9.7%
Anticoagulate if ≥2 (men) / ≥3 (women); strongly consider if =1
Published Clinical Benchmark Cases
Clinical Parameters & Inputs
Computed OutputLow Risk (Score 0)
0points
Diagnostic Interpretation
CHA₂DS₂-VASc is 0 (annual stroke risk ~0.2%). No antithrombotic therapy recommended in a man; in a woman with no other risk factors, anticoagulation is generally not indicated either.
Calculation Breakdown
CHA₂DS₂-VASc Sum
Weighted sum of risk factors =0 / 9 points
Annual Stroke Risk
Cohort-adjusted incidence =~0.2%
Clinical Decision Pearls
- DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) are first-line in eligible non-valvular AF — no routine INR monitoring.
- Mechanical valves or moderate-severe mitral stenosis still require warfarin (DOACs contraindicated).
Limitations & Confounders
- Does not capture bleeding risk — pair with HAS-BLED, which guides modifiable risk, not anticoagulation avoidance.
- Under-weights some risk in the first year after diagnosis; "lone AF" in the young is genuinely low risk.
Evidence & Citations
- Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation. Chest. 2010;137(2):263-272.